Referral is indicated when, despite conservative measures, the patient has persistent and bothersome pain or bleeding from hemorrhoids.
Optimal bowel regimen to promote evacuation of soft, formed stools which may consist of high fiber diet, fiber supplements, stool softeners, and laxatives as needed
Use of topical agents to alleviate discomfort
Behavioral changes (e.g. avoiding long intervals on the commode)
We recommend that patients follow a high fiber diet for at least 6 weeks prior to being referred.